Duodenogastric Reflux after Biliary Procedure

Duodenogastric reflux (DGR) is a poorly understood gastrointestinal process that is defined as reflux of duodenal contents into the stomach. Therapeutic biliary procedures disrupt the function of the sphincter of Oddi. Patients are potential “bile refluxers”. Methods: The present study was carried out to document the incidence and evaluate the clinical significance of DGR after cholecystectomy (n = 9) and choledochoduodenostomy (CDD) (n = 6). Duodenogastric reflux was quantified using continuous intravenous infusion of 99mTc-HIDA. They are studied by symptom evaluation and hepatobiliary scintigraphy. The scintigraphic findings were then compared with those of nine patients who had undergone cholecystectomy alone. Results: The incidence of DGR after CDD was 67% compared to 22% in the cholecystectomy alone group (P < 0.05). None of the patients complained of epigastric distress. Conclusion: 99mTc-HIDA scanning of the hepatobiliary system is a reasonable and reliable method for the quantitative evaluation of DGR. CDD is frequently associated with mild to moderate DGR compared to cholecystectomy alone group. We need to understand these issues to adequately advise patients of the implications of cholecystectomy and CDD.